ENG20160192.pdfE
OV D "0'
1"MOND
U, t "F ED V
121 5TH AVENUE NORTH - EDMONDS, WA 98020
�t$90
PHONE: (425) 771-0220 - FAX: (425) 771-0221
rc.
STATUS: APPLIED ENG20160192
RIGHT OF WAY PERMIT (3-Comme reial)
Permit Number: ENG20160192 Expiration Date:
Job Address: 133 4TH AVE N, EDMONDS Location: 133 4th Ave N
APPLICANT CONTRACTOR
SOUTH COUNTY PLUMBING INC.
PO BOX 6157
EDMONDS, WA 98026 LICENSE 4: EXP:
JOB DESCRIPTION
repair leak in service line under side walk
DIS RUPTION INFORMATION
ASSESSED VALUE: $0.00 PROPERTY AREA: 0
SIDEWALK: ( OXO) DURATION IN MONTHS: 0 FEE: $0.00 STREET DISRUPTION TRENCH CUT: ( 3 X 3 )
PARKING: ( 0X0) DURATION IN MONTHS: 0 FEE: $0.00 YEAR OF OVERLAY: 0 FEE: $0.00
ALLEY: ( 0X0) DURATION IN MONTHS: 0 FEE: $0.00
INDEMNITY The Applicant has signed an application which states he/she holds the City ofEdmonds harmless from injuries,
damages or claims ofany kind or description whatsoever, foreseen or unforeseen, that may be made against the City of'Edmonds or
any ofiis departments or employees, including but not limited to the defense gfany legal proceedings including defense costs and
attorney fees by reason of granting this permit.
TIIECONTRACTOR IS RESPONSIBLEFOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONF.YEAR FOLLOWING TIIEFINAL
INSPECTION AND ACCEPTANCEOFTI EWORK.
• Traffic Control and public safety shall be in accordance with City regulations as required by the City Engineer. Every flagger must
be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the required training in their
possesion.
• Restoration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City approved
material prior to the end of the workday- NO EXCEPTIONS.
• Three sets of construction drawings of proposed work are required with the permit application.
CALL DIAL -A-DIG (1-800-424-5555) BEFORE ANY EXCAVATION
CALL FOR INSPECTION (425) 771-0220 EXT. 1326
24 HOUR NOTICEREQUIRED FOR ALL INSPECTION REQUESTS
THIS APPLICATION IS NOTA PERMITUNUL SIGNED BY THE CITY ENGINEER OR HIS/HER DEPUTY: AND FEES ARE PAID, AND RECEIPTIS ACKNOWLEDGED IN
SPACE PROVIDED.
FILE COPY
INSPECTOR COPY
Printed: Thursdav, Mav 19, 201
APPLICANT COPY
STATUS: APPLIED
ENG20160192
• Restore ROW to City standards
• Restore Landscape to like or better conditions.
• Call for locates of underground utilities prior to any excavation.
• Alert affected residents and/or businesses prior to work start.
• Confonnto approved working drawings and Traffic Control plan.
• Verify clear bore crossings
• Utility patch restoration to be in accordance with Edmonds Standard detail E2.3
Maintain erosion & sedimentation control. Keep street clean.
• Call for required inspections as noted.
• Traffic Control per approved plan and MUTCD. Refer to City of Edmonds traffic control requirements.
• Applicant shall repair/replace all damage to utilities or fiontage improvements in City right-of-way per City standards that is
caused by or occurs during the permitted project.
• Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating fi•om construction sites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents fiom any and all claims for damages of
whatever nature, arising directly or indirectly fi•oni the issuance of this permit. Issuance of this pen -nit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance not limit in any way the City's ability to enforce any ordinance
provision.
INSPECTIONS
• E -Engineering Final
PARTIAL INSPECTION DATE: INITIAL: NOTES:
PARTIAL INSPECTION DATE: INITIAL: NOTES:
FINAL INSPECTION APPROVED DATE: INITIAL:
Of- ED40
PROJECT NAME:
W _190 I N W.13 w
CONTRACTOR:
Mailing Address:
C's
State License #: c,,,
City Business License
aT CD1Ct,ROW PENO.: ENG 261(,-'101'7 /
—
ISSUE DATE: �?'J I q I I
CONTACT:
\ r-,
Phone #: L 2_,�_ __9 ) 3 _Z-',)
Fax #:
Email #:
ADDRESS OR INTERSECTION OF CONSTRUCTION: I
Liability Insurance Bonded
I ROW WORK ASSOCIATED WITH THE FOLLOWING TYPE OF PROJECT: I
Commercial
F1 Multi -Family
Subdivision
F-1 Single Family
F-1 EUC (PUD, VERIZON, PSE,
COMCAST, OVWSD):
Is this permit part of a blanket permit?
City Project
n Other
n Yes n No Job Number
ANY ASSOCIATED PERMITS? BLD44 ENG# -11 h
Traffic Control (Only)
WAS STREET OVERLAYED WITHIN THE LAST FIVE (5) YEARS? YES [:1 NO [:1 Year:
PAVEMENT CUT: El Yes 0 No If yes, indicate size of cut: x
CONCRETE CUT: V Yes F-1 No If yes, indicate size of cut: x
RIGHT-OF-WAY
AREA
CLOSURE
TOTAL
DURATION
(NUMBER OF MONTHS)
Sidewalk 48 Hrs + LF
X
LF
SF
Alley 72 Hrs + LF
X
LF
SF
Parking 72 Hrs + LF
X
LF
SF
APPLICANT ANT TO READ AND SOON
*Traffic control and public safety shall be in accordance with City regulations as required by the City
Engineer. Every flagger must be trained as required by (WAC) 296-155-305 and must have certification
verifying completion of the required training in their possession.
*Restoration isto be in accordance with City codes and Standards. All street -cut trench work shall be
patched with asphalt or City approved material prior to the end of the workday - NO EXCEPTIONS.
INDEMITY: The Applicant has signed an application which states he/she hold the City of Edmonds
harmless from injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen
that may be made against the City of Edmonds or any of its departments or employees including defense
costs and attorney fees by reason ofrg antin this permit
I have read the above statements and understand the permit requirements and acknowledge that I must
follow all requirements in order for the permit to be valid.
SIGNATURE..�-�- �. DATE 5 1 G
Contractor or -Agent-._
NO WORK SHALL BEGIN PRIOR TO PERMIT ISSUANCE